This CEO Is Pushing a Pill For Female Sex Drive. But Does the Science Hold Up?

There are two schools of thought about pink. One is that it is the color of bubble gum and Barbie. Cindy Eckert’s view is that it is the color of business. It is a dominant presence at the offices of her Raleigh, N.C., venture-capital firm, the Pink Ceiling, a fund that advertises its main goal as “to make women really f-cking rich.” It’s an even more dominant presence on Eckert, who defies people to observe the taboo on assessing anyone–especially a woman–by their clothes. She wears some hue of pink every working day, accessorized with hot pink nails, lipstick and shoes. Even her hair seems to have a fuchsia sheen. In the pharmaceutical circles in which Eckert operates, among the white coats and the navy suits, that shade of pink invites judgment. And underestimation. She is fine with that.

Through the firm’s “Pinkubator,” Eckert, 45, is helping bring to market such innovations as a flushable pregnancy test, a decal that can detect a rape drug from a drop of a drink, shelf-stable human milk products for babies and a device that helps train pelvic-floor muscles.

These are not just products for women; they’re products that give women more autonomy and, in particular, more agency over their bodies and sexual choices. And their development is being funded by Eckert’s controversial attempt to answer one of the biggest mysteries of the human body: What is the source of female desire?

In August 2015, when she was Cindy Whitehead, Eckert got the drug Addyi, a (pink) pill engineered to rev up the sex drive of premenopausal women, approved by the Food and Drug Administration (FDA). Within a week, the pharmaceutical giant Valeant bought the drug’s owner, Sprout Pharmaceuticals, a company Eckert had started with her then husband Robert Whitehead. It paid $1 billion. Eckert, now divorced, is using her share of this windfall to try to bottle lightning again, to develop and market products that others overlook because they’re by or for women.

At least, that’s her story.

There’s another story that her critics, most of whom are women, like to tell, in which Eckert’s brand of hyperfeminized pink power is razzle-dazzle and hucksterism. They believe that flibanserin, the generic name for Addyi, which had been turned down twice by the FDA, should never have been approved. One of her critics goes so far as to compare Eckert to Elizabeth Holmes, the now disgraced head of blood-testing company Theranos.

The drug approaches sex by altering the most relevant organ. Unlike Viagra, which has physiological effects on men’s genitals, Addyi works on the brain; it was originally researched to treat depression. Flibanserin increases production of dopamine (the neurotransmitter that governs motivation and anticipation) and regulates serotonin (which governs self-consciousness and mood). Eckert points to brain scans that suggest these are the systems that are malfunctioning in women who have hypoactive sexual desire disorder (HSDD), the otherwise unexplained loss of libido that Addyi is marketed to treat.

But the science of desire–women’s or men’s–is very much up for debate. Not everyone agrees that HSDD is a disease. “These are theoretical speculations that have been grabbed onto by a desperate sexologist and desperate pharmaceutical-industry people who want to find more certainty in a very murky area,” says Leonore Tiefer, a therapist, researcher and educator who opposed the approval of flibanserin. “There’s no measure of this dopamine-serotonin model speculation.”

Indeed, if the biological mechanisms behind women’s desire are poorly understood, the role of neurobiology is even less so. According to Rosemary Basson, director of the University of British Columbia’s Sexual Medicine Program, many people actually feel desire only after they have started making love. There is no benchmark amount of sex drive against which women can measure theirs. “[The pharmaceutical] industry wants that easy desire typical of early relationships that seems to be innate … to be the ‘normal’ state and to find a drug that will replicate that,” Basson told TIME in an email. In June, an article in the Archives of Sexual Behavior, the most respected journal in the field, surmised that “research has not conclusively demonstrated that biology is among the primary mechanisms involved in inhibiting sexual desire in women.” If the problems aren’t biological, then medication is unlikely to work.

Eckert brushes off her learned naysayers. She has never shied from conflict. In fact, in 2017 she sued Valeant, from which she had been fired, for mishandling the drug’s launch. To settle the suit, in November 2017, the company simply gave back to Eckert the drug for which it had paid $1 billion two years before. For free. It threw in a $25 million loan to help her with the relaunch. Why? Partly to get rid of a dead weight. Addyi made less than $10 million last year. By comparison, Viagra has never had less than $1 billion in annual sales.

Having walked away with a huge payoff, Eckert is now back in the fray. Her plans are ambitious. She wants to use the Internet to circumvent the awkward interaction that a woman has with a doctor when the topic is sex and the need is for more of it. Instead, visitors to Addyi’s website who give the right answers to a few queries–Would you like to increase your sexual desire? Why do you want to increase your sexual desire?–are directed to the Care XD website, where they are connected with a doctor. After a telemedicine conversation (a consultation over the phone or video chat), that doctor can prescribe Addyi to be delivered to the customer’s door. Sprout is also lowering the price, from $800 per month to $400, or $99 if users don’t have insurance. On Nov. 1, the pastel-shaded, millennial-friendly online mail-order pharmacy Hims launched Hers, a website for women’s intimate needs, and is promoting Addyi heavily. “Given that men have 26 medications to address their sex drive,” says Hers brand lead Hilary Coles, echoing Eckert’s signature spiel closely, “we felt almost an obligation to give women an option.”

This downsizing of the role of the doctor in prescribing flibanserin does not sit well with many in the field of sexual medicine. Given that the drug has the potential for serious side effects, including passing out (it comes with a black-box warning, the strictest of the FDA’s caution labels, which advises users to abstain from “things that require clear thinking” for six hours), the dangers of taking it could outweigh potential benefits. Unlike Viagra, Addyi has to be taken every night, and its users should not drink alcohol. And nobody has revised the drug’s tepid reviews: it didn’t work for all women, and those for whom it worked reported having only one more “sexually satisfying event” every month.

But the Sprout CEO is undaunted. Visits to the website are up since the relaunch. There are now 20,000 certified Addyi prescribers in the U.S. The drug is about to launch in Canada, and Eckert is working on Europe. Sprout has submitted new alcohol-interaction studies to the FDA. “People have said to me, Why are you such a crusader in this? Nobody’s going to lose their life,” she says. “And my answer to them is, they may well lose their life as they know it.”

One big change since the drug’s first launch is the nature of the discussion about women’s sexual agency. The #MeToo movement lifted a prohibition on talking about intimate experiences, especially acknowledging negative ones. That may play in Addyi’s favor. Eckert uses the language of the movement in her pitch. “We will pick up the much needed and long overdue conversation” about sexual-desire disorders in women, she says, and get past “the shameful silence of feeling it’s taboo societally to talk about what [women] are dealing with.” Expecting women to have sex when they don’t feel desire, she says, sounds like “the Harvey Weinstein defense.”

Her critics counter that Addyi treats a standard female condition–almost a third of women ages 18 to 59 report a problem with decreased sexual desire–as if it were a disease and makes women feel dysfunctional just for being women. Others say low desire is much more likely to be caused by underlying psychological issues–including poor body esteem, relationship difficulties and a lack of sexual agency–and should not be pathologized. They make their own #MeToo case: that women have the right to say no to sex without being thought of as abnormal or in need of fixing.

Eckert argues that the drug is prescribed only to women for whom the absence of desire is a burden. “The hallmark characteristic [of HSDD] is distress,” she says. “I saw women who’d lost their sense of self–they had in many cases lost marriages over this, because when things deteriorate in the bedroom they break down over the breakfast table too. And I struggle to understand objection to women having choice. If she doesn’t want it, she doesn’t take it. It’s her call.”

None of this dissuades her detractors from their belief that Eckert is no champion of women. Before founding Sprout, she and Whitehead marketed a long-acting testosterone implant known as Testopel. Their techniques drew a warning from the FDA, which said that in a pitch to doctors they had overstated the drug’s benefits, understated its risks and promoted unauthorized uses. The material was quickly amended, Eckert says, and had been sent to only 150 M.D.s. (She and Whitehead are both still investors in Sprout. Eckert is engaged to another entrepreneur, Justin Miller, whose current product is premade cookie mixes for dogs.)

But it’s not as if sex therapists don’t have a financial stake here either, if their clients can be cured by medication. One user, Michelle Wilson, 47, of Florida, who has been on Addyi for 20 months, says she never even considered trying therapy, because her lack of desire arrived with menopause and felt to her like a physical issue. “You have to have a need or urge or want,” she says. “A sex therapist is not going to help you in having that desire on your own.” A tapering-off of libido after menopause is generally considered to be normal, not a case of HSDD. Nevertheless, since starting on Addyi, which she takes every other day, Wilson’s sexual frequency has increased from once a month, she says, to at least once a week.

Given testimonials like that, Eckert and her investors believe that Addyi failed the first time not because it didn’t work but because it was mishandled by Valeant, which became mired in a price-gouging scandal that led to the exit of the CEO within months of its acquisition of Addyi. The corporate turmoil might have been a distraction that undercut the product’s launch. “Valeant went through an extraordinary circumstance,” says Eckert. “We don’t have a picture yet of how Addyi will perform.”

In so many ways, Eckert is exactly the type of hero women need to change the way the culture talks about female sexuality: she’s industrious, iconoclastic and stubborn. Her unwillingness to back down in the face of authority can be an asset. Her older brothers, Doug and Brian, tell the story of the year in Fiji she had to go to the principal’s office instead of home-ec classes every day, because on the first day of school, when it was her turn to stand and talk about her father’s job (he was the ambassador), she instead announced that the exercise was pointless. According to her brothers, this was to protect the girl next to her who didn’t want to tell everyone her dad drove a taxi.

She knew something about the exercise her teacher didn’t–that it was not a fun way for everyone to discuss their family. She understands the power of pink in a way others don’t–that a bold color can be a camouflage. So it would be nice to think she had also stumbled onto the key to the puzzle of female desire–that it can be unlocked with a prescription.

But it could also be that Eckert, as her critics say, is using women’s libido and sexual agency the way she uses color, to capture attention and sell. Either way, Eckert has picked a very difficult battle to win. “In the medical system, if I’m asked about sex I’m asked three questions,” she says. “Are you sexually active? Do you want birth control? And do you want to be tested for STDs?”

She wants there to be one more: Are you satisfied? The answer to that question may not be found in a pill.